Evaluation and Management of Drug-Drug Interactions in Patients Hospitalized in Nephrology and Post-Transplant Wards in a Teaching Hospital
Background: Kidney transplant patients usually take a combination of medications after transplantation; hence medication safety becomes an important issue in order to maintain the new organ working properly.
Objective: To evaluate the incidence and risk factors associated with potential drug-drug interactions (pDDIs) in hospitalized patients in Nephrology and Post-transplant wards to improve clinical management of pDDIs by a clinical pharmacist.
Methods: Patients in Nephrology and Post-transplant wards were screened for pDDIs, using the interaction screening program Lexi-comp resource®. After evaluating the detected pDDIs for clinical relevance, intervention was implemented through physicians or nurses for type D and X drug interactions. Intervention feedback, implemented recommendations and any probable adverse drug reactions were documented.
Results: During the study, 399 patients (239 in nephrology and 160 in post-transplant wards) plus 6105 drug orders were evaluated, and a total of 3263 DDIs were identified of which 827 (23.5%) were determined to be D and X classifications, and a total of 89.97 % of all hospitalized cases had at least 1 pDDIs. Factors that had the greatest influence on pDDI incidence included number of drugs and the admitted wards. Patients in post-transplant ward experienced 2.3 times more DDIs than patients in nephrology ward. In total, 78% of class X and D DDIs required intervention of which 75% were accepted and implemented by the physicians and nurses.
Conclusion: Clinically relevant pDDIs are common in patients in Nephrology and Post-transplant wards, and pharmacists play a critical role in detecting and managing this medical problem in hospitalized patients.
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